Gathering place for osteopaths
Clinical skills?
recently I was invited to lecture some physios at a university in london, the topic: abdominal and cvs exams. I was rather shocked as these very pleasant post grad MSc chaps were largely unaware of the need to or how to conduct even a cvs exam let alone things like the cranial nerves. Do all osteopathic degrees teach this as part of an undergrad syllabus or is training that divergent? and how much general medical examination competency do we think is appropriate for student osteopaths anyway?
Replies to This Discussion
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Permalink Reply by Roger Kingston on -
Certainly I was taught this back in the early 90's at the ESO.
I believe we need to be able to do this for one medico legal reasons but also so we can assess our patients safely to determine if osteopathic intervention is in their best interests.
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Permalink Reply by Ross on -
I thought that would be the case Roger. I actually routinely do abdos and cvs on my patients but maybe thats the naturopath in me.What do we think is it almost unosteopathic to not get the most info from the patient we can at a consultation?
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Permalink Reply by Drumist on -
Hi Ross
Certainly it was my experience even way back in the late eighties at The College of Osteopaths to be taught medical clinical/diagnostic skills. As far as I understand it the big difference between us and the physios (in this context!)is that we have always been "primary care practitioners", while they have been seen as a "profession allied to medicine." Physios are therefore not required to make a "medical" diagnosis because this should have been done by the referring doctor.
I think osteopathic graduates should ideally be at least as capable as medical graduates in examination skills. The big issue is what do they then do with the information they gather? If all they do is spot red flags for referral, a significant part of their time as students was wasted. What they should be trained to be able to do is use all the information they gather in an integrated way to guide their osteopathic treatment of their patients.
This was the shortcoming in my training, medical examination/diagnosis was taught by medics, and osteopathic examination/treatment was taught by osteopaths. Understanding as much about our patients as possible is only really valuable if we can then use that integrated knowledge to treat the whole patient osteopathically, whatever 'medical' diagnostic labels they may qualify for.
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Permalink Reply by Drumist on
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We certainly see less patients with systemic disease than do GP's (well I do anyway!) However we do generally spend more time physically examining our patients while the GP's are busy waiting for imaging reports and test results ;) So osteopaths have the potential to be very good at physical examination, but I guess there is little point in spending the time to develop these skills unless they influence our treatment. This is the point I was trying to make. I think it wise to integrate all the examination skills avaialable to us so that we can offer treatment that looks at the whole person (surely an underpinning principle of osteopathy?)
While I agree that we are generally not percieved as being treaters of patients with systemic conditions, we can alter that perception simply by getting good at treating patients who suffer from systemic conditions, after all that's what we did with treating back pain and blah blah blah . . . . I'm sure we all have patients suffering from systemic conditions as well as blah blah blah, so we already have the patients to begin the process with. Get a result with a few of those and they start talking about it. Particularly as they didn't even know we treated patients with such complaints, they thought we just fixed blah blah blah!
I make no claims that my treatment is a panacea, but you never know just how much good you can do untill you try, maybe we need to stop talking ourselves out of trying?
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Permalink Reply by Ross on
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I wholeheartedly agree Andrew, We definatley see less patients with systemic disease, but its not a huge jump to be able to assess them properly and therefore serve them better, certainly in my very short carrear I have caught things that had gone missed by GPs by being this thorough. As someone who is involved in osteopathic education I often try to make my students look at the anterior aspect of patients as well as posterior. For example if you look at illiopsoas (which if you dont, for all sorts of sound anatomical reasons, you have no business treating LBP, in my humble opinion) then its not a huge amount of spent time more to "medically" as well as osteopathically examine the viscera, which is also relevant to whats happening I reckon.
From my point of view to be truly osteopathic (whatever that means) we have to take into consideration the patient's presentation from a maximally holistic and physiological point of view and I think abdo/circulatory exams in particular (med&osteo) have a place in that. I realise that this may not fit into many people's paradigm of what is possible in one financially beneficial appointment. but having been an exponent of very high volume practice and quite the diametrically opposed opposite (as I am nowadays) I would say to all those out there who think they are being osteopathic in 20 mins or less- AT Still would turn in his grave.
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Permalink Reply by Drumist on
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Yes I see that our individual practice profile will have a big impact on what systemic conditions/dysfuctions we are likely to see. My current practice includes LOTS of acute musculoskeletal presentations (builders, farmers,fishermen (yes all men so far).) But I also have and always have had a good age spread (6 days to 90+ years) and I see plenty of patients with chronic/degenerative conditions for which "nothing more can be done." In a fair number of these a broad osteopathic approach often seems to help improve their overall health.
I had a 79 year old, very recently ex-smoker a few weeks ago, presenting with mid thoracic spine and chest pain, along with a very productive cough and dyspnoea. By addressing his overall function not only was his pain resolved (Ok it might have just been coincidence) but on his second visit, after the inhaler his GP had prescribed hadn't made any difference, and the GP had then told him there was nothing else he could do, I saw his dyspnoea ease while he was still on my table (obviously I was using VFAP - very fast acting placebo.) By the next visit he was no longer coughing and had no sign of dyspnoea, and was a much happier man.
I do however think you are right Rick, to keep a degree of scepticism about traditional osteopathic teachings, because that's necessary in order that you can be truely open minded, which is a just a question of keeping an appropriate balance.
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Permalink Reply by Ross on
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I think my above post appears a bit harsh, so please dont think im having a go at you guys! :) I totally agree with you on treatment times Rick and for sure Andrew I think all practices are demographically different. My point perhaps is that I find osteopathy a bit ill at ease with itself sometimes what with classical thinking saying we can treat some systemic disease (dont completely disagree) visceral osteopathy saying lets do bloodless surgery and cranial osteopathy saying lets directly affect the brain, but with all this scope of practice I occassionally do come across current osteopathic thinking which shys away from simple clinical assessment pertinant to non osteopathic dysfunction in these areas. "ooh no thats what doctors do!"
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Permalink Reply by Ross on
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Well I just cant really disagree with anything you say there Kuno, maybe the lack of importance of specific conditions but I know what you mean. My point could be that perhaps The two forms of assessment are all part of the same thing and osteopaths should be competent in all manner of examination pertinant to primary care; from a frank lesion of the cranial nerves all the way to the subtle nuances of the sympathetic nervous system and its effects on the skin over the paravertebral gutter (just 2 examples of course). I think though that a weird fear of the biomedical prevails in many, which I feel is a bit daft really. Perhaps its relativley moot in a way as those practitioners who dont look at the organism in its totality are possibly the same chaps that make diagnostic/clinical decisions based solely on how the spine feels if we flex it, what the patient looks like if they bend forward or what that individual's hands feel like on the patients head at any given time.
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Permalink Reply by Hume O'Rous on -
Hi Rick,
What are your fees for your initial consult, and your follow-ons?
Kind regards
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